Disrupting the Cycles that Shorten Lives in Metro Detroit

Dr. Abdul El-Sayed, outgoing director of the Detroit Public Health Department, recently gave a talk at TEDx University of Michigan about how intergenerational poverty affects public health -- "why public health is about place.”

El-Sayed, a native Detroiter, was appointed by Mayor Mike Duggan in 2015 to lead a non-profit run agency with a goal to disrupt intergenerational poverty. In order to do this, it's important to think upstream and tackle feedback cycles, he said.

El-Sayed presented assumptions, facts and some programs Detroit is hoping will break those cycles.

Assumptions & Facts

"We assume that health is about lifestyle, that we have a choice about the kind of health that we might experience,” El-Sayed said.

Genetics and lifestyle are two assumptions. But there are places where health is worse than other places, and place actually matters more than lifestyle and genetics, he said, showing a U.S. map of premature death per 100,000.

People who live in Detroit have a shorter life expectancy, among the shortest in the nation, according to 2016 researchers at Virginia Commonwealth University. But public health officials in Detroit have known the facts of the map for a long time.

Health experience is not the same in every place for a number of reasons, including income. According to the talk, when life expectancy is plotted along data on income, the picture shows that higher income brackets experience better health.

In Detroit, a city of 677,000 , other factors like food deserts, lack of transportation and neighborhood safety also contribute to intergenerational poverty and the ongoing cycles of poor health.

Poor people in Detroit can’t get to a grocery store to get fresh, healthy food because it's three miles away, he said. They also can’t always exercise when they get home from work. Their neighborhoods are unsafe, and going outside for a jog, for example, is not always advisable.

"And, we cannot ignore the fact of race,” he El-Sayed.

In summary, Detroit’s poor are:

  1. Spread across a big city that is highly vacant. From 2000-2010, a lot of people exited Detroit.
  2. Concentrated in the places they were placed 60 years ago. A real estate map of redlining from the late 1930s showed where people of particular races could live and not live in Detroit.
  3. Limited by transportation. About 60 percent in Detroit lack or only have limited access to a car. Those with some access either share, or rely on cars that are in unreliable condition. Motor city is also not known for its public transportation -- highways had always been the focus.
The reason place matters is that health is about access to food, exercise, education, healthcare and social support and about exposure to things like trauma, violence and racism," said El-Sayed.

Four Ways to Disrupt

“Public health is what we, as a society, do collectively to assure the conditions for people to be healthy,” El-Sayed said.

Starting with a man having a heart attack, El-Sayed asks what are the causes. Beyond the medically-correct answer, public health departments must look upstream at direct causes, he said.

That heart attack costs that man about $670,000. What if that man then had to sell his home and move into an older home in a neighborhood that is ripe with hazards like lead poisoning, asthma or violence -- all which affect that child's education and ability to learn? Then, cycles continue as that child raises his own family in the same circumstances.

The Detroit Health Department is working to systematically dismantle poverty and poor health feedback cycles in a number of ways, including the following four:

#1 Infant Health

Because infant mortality rates are higher among the poor, Detroit is building a Sister Friends program through which is teaches mentors how to walk pregnant women through the cycles of pregnancy -- and all the resources available to them that can give their babies a better start in life.

#2 Teen Pregnancy

In Detroit, teen pregnancy leads to a 50 percent likelihood of dropping out of high school. Detroit is taking a three-pronged approach to implementing long active reversal contraceptives (LARCs). They are working to make them available to doctors, developing a campaign so people know that LARC's last 3-5 years and are reversible and are available and establishing clinics that are discreet and not stigmatizing.

#3 Asthma

To address asthma, because Detroit has an asthma hospitalization rate three times as high as the state of Michigan, the public health department is equipping children with inhalers that have sensors which enable the city to provide families with real-time information on environmental exacerbation risks.

#4 Vision 

About 28 percent of the 35,000 student that test positively for vision deficits do not get glasses. Detroit's "Vision to Learn" program provides vision exams at schools, and then delivers glasses within 2 weeks to students that need them.

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